Some limitations for this study should be taken in consideration. First, the response rate was rather low. A study by Charles et al. (2004) who also sent out questionnaires to physicians attained a much higher response rate (76% as opposed to a 25% response rate in this study). The low response rate might be due to the fact this study was undertaken during the summer. It might also be that those physiatrists that took to the time to participate in this study are the ones more open to new research findings and more likely to adopt them in practice. If this is so, the use of shared decision-making might be over-reported.
The use of shared decision-making among physiatrists might also be lower in reality, due to social desirable answering by the respondents. The same may be so for the reported use of decision aids and physiatrists’ attitude towards the use of these aids. Knowing a patient centered approach is advocated, the respondents might have felt uncomfortable reporting practices and opinions not in line with this view.
Physiatrists were asked to indicate which patient group they deal with primarily. They were also asked to keep this group in mind while answering questions about the applicability of shared decision-making. Many respondents however, did not restrict their answer to just one group. It is unclear which patient group they had in mind, when asked about their opinion. The validity of the statements on the extent to which shared decision-making is at place for certain groups of patients could be enhanced by clearly stating the patient group in the question, knowing this is a group the physiatrist is familiar with.
A question that also proved difficult to answer, was the question how much time “an average consult” took. Respondents often indicated the average time they had for a first intake as well as the time they spend on succeeding consultations. Future research might consider asking more specifically how long one of both types of consultations lasts or focus just on the first consultations during which treatment decisions are made.
Finally, the concept of a decision aid might not be well understood by the respondents. Physiatrists often interpreted the question which aid they were familiar with, as asking which outcome the consultation had or what advice was given at the end of a consultation (e.g. “giving someone more time to think about it”). Some interpreted decision aids as ways the physiatrists uses to explain something (e.g. “the use of an anatomical model”). Giving more information on key characteristics of a decision aid before asking physiatrists how familiar they are with them can therefore be recommended. Perhaps providing the questionnaire in a digital format can make this easier, as pictures of interactive websites can be inserted.
Results showed that the shared decision-making approach is currently the most commonly used approach and also the one for which physiatrists reported the highest levels of comfort, indicating that this approach is well at place in rehabilitation healthcare. A considerable gap between these two self-reported measures was also found though. The patient receiving conflicting recommendations and having difficulty accepting the disease were among the factors identified as barriers for greater involvement of patients in the treatment decision-making process.
Physiatrists indicated to use decision aids and hold a positive attitude towards the use of these aids, though more elaborate aids still need to find their way to common practice. A broader implementation of decision aids is likely to support shared decision-making, as it can increase patient’s knowledge before the consultation – a factor reported to be seen as a facilitator to shared decision-making.
No relation was found between contextual factors or physiatrists’ factors and physiatrists’ attitude towards shared decision-making. Results did suggest that the cognitive abilities of the patient influence physiatrists’ attitude towards patient involvement in decision-making. Further research might provide more insights on the use of a patient centered decision-making approach with patients suffering cognitive limitations. Research designs other than self-reported may also provide valuable additional information on shared decision-making in the rehabilitation healthcare.
I would like to thank dr. C.H.C. Drossaert and drs. J.A. van Til for their supervision during this research. Their feedback was always useful and gave me confidence and inspiration for the next steps to take. Also, I’m very grateful for the support I received from my close friends and family. Not only would I like to thank them for their support during this study, but also for their trust in me during the years that preceded it. Thanks.
Barratt, A., Trevena, L., Davey, L.M. & McCaffery, K. (2004). Use of decision aids to
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